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Environmental Information Form <br /> Part B <br /> DATE: g 29 r g <br /> (To be Completed By Applicant ) <br /> NOTE : In completing this form, use additional sheets if necessary. <br /> Answer all questions to the best of your ability. If a question <br /> is not applicable to your project, write NA (not applicable ) . <br /> Please do not leave blanks . Incomplete forms cannot be accepted. <br /> PERSON COMPLETING FORM PROPERTY OWNER \ AGENT OF OWNER <br /> Name \t-11 L.L\p4A <br /> Address (-p C -»C 6-("7 <br /> City \- i—�'�c�O I(,-- <br /> State/Zip <br /> Phone 2p9 -72-1- 34 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Zone Reclassification, Minor Subdivision, Q Site Approval, <br /> Zone variance, 0 Other : <br /> 2 . Project location: �C�2.2� l=- ���• 88 IJ�X� G <br /> Describe the project; i .e. , request being made and nature of use . <br /> Identify specific project components : l�w«�r��� �� A62\C •Tt�.. <br /> 3 . Total acreage of project: .(D # of existing parcels : <br /> Assessor Parcel <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date: <br /> 5 . Other permits and approvals (County, Regional, State and Federal) <br /> required for this project: <br /> PERMIT _ AGENCY <br /> Minor Subdivision - 7 - ( 6/86) <br />